The Peter Attia Drive
The Peter Attia Drive will feature guests and experts that will offer advice and insight to help you optimize performance, health, longevity, critical thinking, and life. It’s hosted by Stanford M.D., TED speaker, and longevity expert Dr. Peter Attia, founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City.
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#373 – Thyroid function and hypothyroidism: why current diagnosis and treatment fall short for many, and how new approaches are transforming care | Antonio Bianco, M.D., Ph.D.
11/17/2025
#373 – Thyroid function and hypothyroidism: why current diagnosis and treatment fall short for many, and how new approaches are transforming care | Antonio Bianco, M.D., Ph.D.
Antonio Bianco is a world-renowned physician-scientist and expert in thyroid physiology and metabolism. In this episode, Antonio explores the complex biology of thyroid hormone production, conversion, and regulation—highlighting how deiodinase enzymes modulate hormone activity at the tissue level and why that matters for interpreting lab results. He discusses the shortcomings of relying solely on TSH as a marker of thyroid function, the ongoing debate around combination therapy with T3 and T4 versus standard T4 treatment, and how genetics, tissue sensitivity, and individual variability influence thyroid hormone metabolism. The conversation also examines how hypothyroidism affects energy, mood, cognition, and longevity; why some patients remain symptomatic despite “normal” labs; and how future research could reshape treatment paradigms. We discuss: How the thyroid produces, stores, and activates hormones like T4 and T3 to finely regulate thyroid activity [2:45]; How fasting alters thyroid hormones to conserve energy [12:45]; Action of the deiodinases: how D1, D2, and D3 enzymes control the activation and inactivation of thyroid hormones [19:15]; The normal function of thyroid hormone and the roles of the hypothalamus, pituitary gland, and deiodinases in maintaining hormonal balance [23:30]; Why understanding thyroid physiology is essential for proper diagnosis and treatment of hypothyroidism [33:45]; Testing for thyroid hormones: understanding free vs. total levels, the limitations of current T3 assays, best practices, and more [36:00]; Genetic and sex-based variability in thyroid hormone regulation and their limited clinical significance [43:45]; Hyperthyroidism: causes, symptoms, diagnosis, and treatment options [46:00]; Hypothyroidism: diagnosis and autoimmune causes of hypothyroidism [56:30]; More on hypothyroidism: diagnostic biomarkers, antibody patterns, and non-autoimmune presentations [1:05:00]; Thyroid hormone replacement therapy [1:15:15]; More on thyroid replacement strategies: exploring the evidence gaps, mortality signals, effects on lipids, and more [1:28:00]; Hypothyroidism basics: causes, antibody implications (including pregnancy), and how to make the diagnosis before choosing therapy [1:35:15]; Thyroid medication: compounded controlled-release T3, brand name versus generic, and what Antonio prescribes to newly diagnosed hypothyroid patients [1:42:45]; Redefining treatment success: why normalizing TSH isn’t always enough for patients with hypothyroidism [1:54:45]; Case studies: analysis of two unusual cases of thyroid disease [1:57:00]; Dangers of supplementing with high levels of iodine, and female-specific risk of thyroid disease [2:05:45]; Case study of a patient who presents with elevated TSH but no symptoms [2:09:30]; How future research could reshape treatment, and Antonio’s new book called “Rethinking Hypothyroidism” [2:13:15]; and More. Connect With Peter on , , and
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#372 - AMA #77: Dietary fiber and health outcomes: real benefits, overhyped claims, and practical applications
11/10/2025
#372 - AMA #77: Dietary fiber and health outcomes: real benefits, overhyped claims, and practical applications
In this “Ask Me Anything” (AMA) episode, Peter breaks down the science of dietary fiber, moving beyond the blanket advice to “eat more fiber” to uncover what it actually does in the body and where its benefits are truly supported by evidence. He explains how different types of fiber—soluble, insoluble, viscous, and fermentable—affect digestion, satiety, weight management, and glycemic control, and compares their impact to other, more potent metabolic tools. Peter also examines how certain fibers influence lipid metabolism and cardiovascular risk, evaluates the strength of evidence for fiber’s role in colorectal cancer prevention, and highlights why some individuals may not tolerate specific fibers well. The discussion concludes with practical guidance on moving past generic fiber targets toward a more strategic and personalized approach that maximizes the true benefits of fiber. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Why it’s time to re-examine the evidence behind dietary fiber recommendations [2:00]; Why it’s hard to isolate fiber’s true effects on health: the limits of nutritional epidemiology [5:45]; Defining dietary fiber: what it is, how it’s digested, and why different types have different effects [8:15]; Understanding fiber properties: how solubility, viscosity, and fermentability shape its effects in the body [11:15]; Resistant starches explained: types, food sources, and how cooking and cooling influence their benefits [16:30]; A framework for evaluating each of the major health claims linked to fiber [19:15]; How fiber can support weight loss: mechanisms, realistic expectations, and its complementary role to broader dietary strategies [20:30]; How fiber modestly improves glycemic control by reducing glucose spikes and insulin demand [26:15]; How fiber modestly lowers LDL cholesterol and supports cardiovascular health [34:30]; How fiber compares to other available tools and strategies for managing lipids, blood sugar, and weight [42:00]; Fiber’s role in colon cancer prevention: mechanisms, evidence, and limitations [45:30]; Is fiber necessary for colon cancer prevention in otherwise healthy individuals? [53:30]; Why some people have adverse reactions to certain types of fiber, and how to manage them [56:00]; A general strategy for dietary fiber: combine multiple fiber types through whole foods and supplements [58:45]; Why total fiber intake is more important than the ratio of soluble-to-insoluble fiber [1:02:45]; The optimal timing and context for consuming fiber to maximize blood sugar control and metabolic benefits [1:05:00]; How food processing affects the functional properties of fiber, the differences between supplement forms and natural sources, and why whole foods generally remain the best option [1:06:45]; Fiber’s potential to interfere with medication absorption [1:09:30]; How to safely increase fiber intake: ramp up gradually and stay hydrated [1:12:00]; Final takeaway on fiber: modest benefits, strong rationale, low downside [1:13:00]; Peter’s carve-out: lessons and inspiration from the Acquired podcast [1:14:30]; and More. Connect With Peter on , , and
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#371 – Women’s sexual health: desire, arousal, and orgasms, navigating perimenopause, and enhancing satisfaction | Sally Greenwald, M.D., M.P.H.
11/03/2025
#371 – Women’s sexual health: desire, arousal, and orgasms, navigating perimenopause, and enhancing satisfaction | Sally Greenwald, M.D., M.P.H.
Sally Greenwald is an OB-GYN who specializes in women’s sexual health from a hormonal and physiologic perspective, with expertise spanning desire, arousal, pelvic floor function, contraception, and menopause care. In this episode, she explains why sexual health is a vital component of overall well-being, exploring topics such as the drivers of desire, the anatomy of sexual function, myths and realities around orgasm, and the role of hormones in perimenopause and menopause. She also covers vaginal and pelvic health, pain with sex, evidence-based therapies for low desire and arousal, how contraception and medications can affect sexual function, and practical strategies for enhancing sexual satisfaction and maintaining intimacy across life stages. This episode offers a comprehensive, evidence-based discussion with immediate real-world relevance for women as well as for men who want to better understand their partners. We discuss: How sexual health influences physical health, emotional well-being, and relationships [3:15]; Understanding the physiology of the female orgasm, sexual comfort and satisfaction, and the disparity between men and women [12:45]; Foreplay, the science of desire, and methods to help women cultivate arousal and connection [19:00]; The physiology and sources of female lubrication, the role of clitoral nerve anatomy in pleasure, and the use of lubricants and vibrators to enhance comfort and sexual health [23:45]; Understanding female anatomy and what is needed for orgasm [31:15]; Understanding sexual desire, how to cultivate it, the role of hormones, and testosterone therapy in women [41:15]; Personalizing perimenopause care: how desire for ovulation guides the choice between contraception and menopausal hormone therapy [49:30]; Considerations for choosing contraceptives and hormonal therapies during perimenopause [59:45]; Factors negatively affecting desire, and why female libido persists with age and fluctuates across the menstrual cycle [1:11:00]; How sexual trauma and physical pain can affect sexual health, and evidence-based strategies for recovery [1:15:15]; Vaginal care routine: lubricants, moisturizers, topical hormones, and other approaches for vaginal health [1:19:15]; Tips for sexually satisfying your female partner [1:25:45]; The pharmacology of arousal: various treatments for low sexual desire in women [1:30:30]; Sex during and after pregnancy: impact on arousal, safety of sex, and how to manage postpartum recovery and pain [1:37:45]; How Sally would redesign sex education [1:42:15]; Sally’s optimism about a new era in women’s sexual health [1:49:00]; and More. Connect With Peter on , , and
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Longevity 101: a foundational guide to Peter’s frameworks for longevity, and understanding CVD, cancer, neurodegenerative disease, nutrition, exercise, sleep, and more (re-broadcast)
10/27/2025
Longevity 101: a foundational guide to Peter’s frameworks for longevity, and understanding CVD, cancer, neurodegenerative disease, nutrition, exercise, sleep, and more (re-broadcast)
In this special episode, Peter provides a comprehensive introduction to longevity, perfect for newcomers or those looking to refresh their knowledge. He lays out the foundational concepts of lifespan, healthspan, and the marginal decade. Additionally, Peter discusses the four main causes of death and their prevention, as well as detailing the five key strategies in his longevity toolkit to improve lifespan and healthspan. Detailed show notes provide links for deeper exploration of these topics, making it an ideal starting point for anyone interested in understanding and improving their longevity. We discuss: Key points about starting exercise as an older adult [2:45]; Overview of episode topics and structure [1:45]; How Peter defines longevity [3:45]; Why healthspan is a crucial component of longevity [11:15]; The evolution of medicine from medicine 1.0 to 2.0, and the emergence of medicine 3.0 [15:30]; Overview of atherosclerotic diseases: the 3 pathways of ASCVD, preventative measures, and the impact of metabolic health [26:00]; Cancer: genetic and environmental factors, treatment options, and the importance of early and aggressive screening [33:15]; Neurodegenerative diseases: causes, prevention, and the role of genetics and metabolic health [39:30]; The spectrum of metabolic diseases [43:15]; Why it’s never too late to start thinking about longevity [44:15]; The 5 components of the longevity toolkit [46:30]; Peter’s framework for exercise—The Centenarian Decathlon [47:45]; Peter’s nutritional framework: energy balance, protein intake, and more [58:45]; Sleep: the vital role of sleep in longevity, and how to improve sleep habits [1:08:30]; Drugs and supplements: Peter’s framework for thinking about drugs and supplements as tools for enhancing longevity [1:13:30]; Why emotional health is a key component of longevity [1:17:00]; Advice for newcomers on where to start on their longevity journey [1:19:30]; and More. Connect With Peter on , , and
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#370 - AMA #76: Peter evaluates longevity drugs, aspirin for CVD, and strategies to improve muscle mass — proven, promising, fuzzy, noise, or nonsense?
10/27/2025
#370 - AMA #76: Peter evaluates longevity drugs, aspirin for CVD, and strategies to improve muscle mass — proven, promising, fuzzy, noise, or nonsense?
In this “Ask Me Anything” (AMA) episode, Peter revisits the “proven, promising, fuzzy, noise, nonsense” scale and applies it to a variety of popular topics. He begins with a refresher on what each category represents before classifying a range of interventions based on the strength of their supporting evidence. The conversation spans three main areas: drugs for geroprotection (including GLP-1 receptor agonists, SGLT2 inhibitors, methylene blue, and telomere-lengthening supplements), the use of low-dose aspirin for cardiovascular disease prevention, and strategies to improve muscle mass through optimal protein intake and follistatin gene therapy. This episode provides a clear, evidence-based overview for listeners seeking to understand where these popular health and longevity interventions stand on the spectrum of scientific credibility. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: A scale for evaluating scientific claims: proven, promising, fuzzy, noise, or nonsense [1:30]; Strong convictions, loosely held: the mindset that separates great scientists from the rest [7:30]; GLP-1 receptor agonists: are there benefits beyond improving metabolic health and promoting weight loss? [12:45]; GLP-1 drugs and the brain: exploring the potential cognitive benefits [18:45]; GLP-1 drugs and lifespan: examining the evidence for potential geroprotective effects [23:00]; Rapamycin and geroprotection: why it remains in the “promising” category [25:45]; SGLT2 inhibitors and their potential geroprotective effect [27:30]; Methylene blue: examining the evidence of an anti-aging effect [34:45]; Methylene blue’s potential neuroprotective effects: limited and inconsistent evidence in humans, and the challenges of dosing and safety [41:15]; Telomeres: what they are, how they relate to aging, and why telomere-lengthening supplements lack credible scientific evidence [43:45]; Does the idea of targeting telomere length to extend lifespan have scientific merit? [50:15]; Low-dose aspirin for cardiovascular disease prevention: weighing its clot-prevention benefits against bleeding risks across different populations [55:00]; Rethinking the protein RDA: why most people need twice the recommended amount for muscle health [1:00:45]; Debunking the protein–cancer myth: why higher protein intake doesn’t promote tumor growth [1:06:15]; The biology of follistatin and myostatin, and why follistatin gene therapy has become an emerging topic of interest for muscle growth [1:13:15]; Follistatin gene therapy for muscle growth: state of the evidence in animals and humans, and the technical challenges and regulatory barriers [1:17:00]; Why injectable follistatin is theoretically possible but impractical for real-world use [1:23:15]; and More. Connect With Peter on , , and
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#369 ‒ Rethinking protein needs for performance, muscle preservation, and longevity, and the mental and physical benefits of creatine supplementation and sauna use | Rhonda Patrick, Ph.D.
10/20/2025
#369 ‒ Rethinking protein needs for performance, muscle preservation, and longevity, and the mental and physical benefits of creatine supplementation and sauna use | Rhonda Patrick, Ph.D.
Rhonda Patrick is a scientist, health educator, and host of the FoundMyFitness podcast whose work explores the intersection of nutrition, aging, and disease prevention. In this episode, Rhonda joins Peter for part two of his deep dive on protein, continuing last week’s discussion with David Allison and expanding the conversation to include creatine supplementation and sauna use. She discusses why the current RDA for protein is insufficient, how much more is needed to maintain muscle mass and prevent frailty, how activity level and aging influence protein requirements through mechanisms such as anabolic resistance, and how to determine optimal protein intake. The conversation also covers creatine’s proven effects on strength, endurance, and performance; its overlooked benefits for cognition and brain health; and the optimal dosing for different populations. Rhonda closes with the science behind sauna use, including its cardiovascular and cognitive benefits, the role of heat shock proteins, and practical guidance on temperature and duration. We discuss: Why the current protein RDA is too low, and why maintaining sufficient amino acid intake is vital for muscle preservation and health [3:30]; The case for raising the protein RDA by at least 50% [9:45]; Anabolic resistance: why inactivity—more than aging—blunts the body’s response to protein, and how resistance training restores it [14:00]; How sarcopenia develops, the profound effect of frailty on quality of life, and why it’s crucial to build and maintain muscle early [20:00]; Finding the optimal protein dose [25:00]; Why aiming higher is smarter: the case for targeting 2g of protein per kg of body weight in the real world [32:15]; Protein needs for pregnant women and growing adolescents [37:30]; Why higher protein intake is crucial when trying to lose fat while preserving or gaining muscle [39:45]; GLP-1 drugs: protein needs, muscle preservation, dosing strategies, evidence of broader health impacts, and more [43:45]; How overweight individuals should calculate protein needs based on target body weight [50:45]; Unpacking a misunderstood topic: the relationship between protein intake, mTOR activation, and longevity [52:00]; Why it’s unclear whether rapamycin is geroprotective in humans, and how misinterpreted animal data have fueled misconceptions about protein or mTOR activation being harmful [1:00:45]; The unmatched longevity benefits of exercise, its synergy with higher protein intake, and Peter’s recommended protein intake [1:06:15]; How Rhonda became fascinated with creatine—a well-studied, safe, and effective supplement for improving exercise performance [1:09:00]; Creatine for the brain: how higher doses may enhance cognition under stress and support resilience against aging and disease [1:16:30]; Optimal creatine use: dosing for adults and teens, safe product selection, debunking kidney myths, and more [1:25:45]; Sauna: how deliberate heat exposure mimics exercise, boosts cardiovascular and brain health, and shows promise for improving mood and mental resilience [1:32:15]; The benefits of sauna for reducing risk of dementia, and why hotter may not be better [1:41:15]; The FoundMyFitness podcast [1:45:30]; and More. Connect With Peter on , , and
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#368 ‒ The protein debate: optimal intake, limitations of the RDA, whether high-protein intake is harmful, and how to think about processed foods | David Allison, Ph.D.
10/13/2025
#368 ‒ The protein debate: optimal intake, limitations of the RDA, whether high-protein intake is harmful, and how to think about processed foods | David Allison, Ph.D.
David Allison is a world-renowned scientist and award-winning scientific writer who has spent more than two decades at the forefront of obesity research. In this episode, David joins for his third appearance on The Drive to bring clarity to one of the most contentious topics in modern nutrition—protein. He explores the historical pattern of demonizing macronutrients, the origins and limitations of the RDA for protein, and what the evidence really says about higher protein intake, muscle protein synthesis, and whether concerns about harm are supported by actual data. He also discusses the challenges of conducting rigorous nutrition studies, including the limits of epidemiology and crossover designs, as well as conflicts of interest in nutrition science and why transparency around data, methods, and logic matter more than funding sources. The episode closes with a discussion on processed and ultra-processed foods, the public health challenges of tackling obesity, and whether future solutions may depend more on drugs like GLP-1 agonists or broader societal changes. This is part one of a two-part deep dive on protein, setting the stage for next week’s conversation with Rhonda Patrick. We discuss: The cyclical pattern of demonizing different macronutrients in nutrition and why protein has recently become the latest target of controversy [3:15]; The origin and limits of the protein RDA: from survival thresholds to modern optimization [6:30]; Trust vs. trustworthiness: why data, methods, and logic matter more than motives in science [13:30]; The challenges of nutrition science: methodological limits, emotional bias, and the path to honest progress [17:15]; Why the protein RDA is largely inadequate for most people, and the lack of human evidence that high protein intake is harmful [30:30]; Understanding the dose-response curve for muscle protein synthesis as protein intake increases [45:15]; Why nutrition trials are chronically underpowered due to weak economic incentives, and how this skews evidence quality and perceptions of conflict [48:15]; The limitations and biases of nutrition epidemiology, and the potential role of AI-assisted review to improve it [56:15]; The lack of compelling evidence of harm with higher protein intake, and why we should shift away from assuming danger [1:04:15]; Pragmatic targets for protein intake [1:09:30]; Defining processed and ultra-processed foods and whether they are inherently harmful [1:16:15]; The search for a guiding principle of what’s healthy to eat: simple heuristics vs. judging foods by their molecular composition [1:25:00]; Why conventional public health interventions for obesity have largely failed [1:38:15]; Two ideas from David for addressing the metabolic health problem in society [1:42:30]; The potential of GLP-1 agonists to play a large role in public health [1:46:30]; and More. Connect With Peter on , , and
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#367 - Tylenol, pregnancy, and autism: What recent studies show and how to interpret the data
10/06/2025
#367 - Tylenol, pregnancy, and autism: What recent studies show and how to interpret the data
In this special episode of The Drive, Peter addresses the recent headlines linking acetaminophen (Tylenol) use during pregnancy to autism in exposed children. Recognizing the confusion these claims have sparked among patients, listeners, and the broader public, Peter uses this episode to provide a framework for thinking critically about complex conditions and the research related to them. He highlights the dramatic rise in autism diagnoses over recent decades, noting that multifactorial conditions rarely have a single cause, and emphasizes the importance of resisting oversimplified explanations. Peter also stresses that humans are not naturally wired for scientific thinking, making disciplined frameworks like the Bradford Hill criteria essential for evaluating causality in epidemiology. Ultimately, he uses this framework to explore the evidence surrounding acetaminophen use during pregnancy and its potential link to autism. We discuss: Laying the groundwork for this discussion, the rise in autism rates, and the value in using frameworks [1:00]; The FDA pregnancy drug categories, where Tylenol falls within that framework, and a structured method for evaluating scientific evidence and causality [6:00]; What exactly are the claims being made about acetaminophen and autism? [13:45]; The increase in autism rates and why so many things are being linked to autism: the multiple comparisons problem [15:00]; Evaluating the review paper that triggered the recent concern over acetaminophen and autism [21:45]; Breaking down the largest studies on prenatal Tylenol exposure and autism: is there a causal link? [35:00]; Why observational studies can’t prove causality, the role of confounding variables, and the importance of frameworks like the Bradford Hill criteria [43:30]; Applying the Bradford Hill criteria: testing the case for Tylenol and autism [45:45]; Putting it all together to answer the question: Does acetaminophen use during pregnancy increase the risk of autism? [56:15]; If autism risk is overwhelmingly genetic, what explains the dramatic rise in autism diagnoses? [59:15]; Other risk factors for autism: parental age, maternal health, environment, and where Tylenol fits in [1:09:15]; Medication use during pregnancy: balancing risks, benefits, and FDA categories [1:15:15]; Considerations for taking Tylenol during pregnancy [1:19:30]; Final thoughts: critical thinking, balanced risk assessment, and the importance of context when evaluating medications like Tylenol during pregnancy [1:22:30]; and More. Connect With Peter on , , and
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#366 ‒ Transforming education with AI and an individualized, mastery-based education model | Joe Liemandt
09/29/2025
#366 ‒ Transforming education with AI and an individualized, mastery-based education model | Joe Liemandt
Joe Liemandt is a software entrepreneur turned education reformer who left Stanford in 1989 to found Trilogy, a highly profitable private software company, before pivoting to transforming K-12 learning. In this episode, Joe shares how he transitioned from leading a global software enterprise to becoming principal of Alpha School, where his focus is building a mastery-based, individualized education model that leverages AI as the missing infrastructure for large-scale change. He details the shortcomings of traditional K-12 education, explains how Alpha replaces conventional seat time with focused academics, and outlines the role of AI tutors and human coaches in helping students accelerate through material. Joe also discusses early results, the data-driven systems that track progress, and his ambitious plan to reach a billion children in the next 20 years by combining cutting-edge technology with proven learning science. We discuss: Joe’s early interest in AI and the story of how he quit school to build Trilogy [4:45]; Joe’s first encounter with Alpha School and how it sparked his journey into education innovation [8:15]; America’s declining K-12 performance and the hidden power of mastering fundamentals [13:00]; How traditional time-based grade progression undermines later learning, and how mastery-focused instruction can transform student achievement [20:30]; Motivation as the key to high-level learning: how Alpha School fosters motivation with its “Timeback” model and leverages AI to accelerate learning [28:45]; Core principles of learning: how high standards, mastery-based instruction, and supportive struggle foster both academic excellence and personal growth [35:45]; Breaking down self-imposed limitations with foundational skills, defined time requirements, and a mastery model [41:15]; Using short-term extrinsic rewards to help students overcome limiting beliefs and ignite lasting intrinsic motivation [46:45]; $100 for 100: a simple but powerful incentive system that helps students fill academic gaps and master fundamentals [53:45]; How AI is the pivotal technology that can finally allow proven learning science to scale and unlock unprecedented student potential [57:45]; The emergence of generative AI that catalyzed Joe’s billion-dollar investment in education [1:09:45]; The path and obstacles to integrating Alpha’s AI-powered model into mainstream education [1:12:00]; Reimagining schooling from the ground up across five key dimensions [1:22:30]; The potential of this educational approach to reduce inequality in academic success [1:30:00]; Why the biggest challenge to scaling Alpha’s AI-driven education is cultural adoption and systemic redesign [1:34:00]; Peter’s daughter’s experience at Alpha School [1:38:30]; Alpha School’s expansion plans and need for people and resources for maximum impact [1:42:30]; and More. Connect With Peter on , , and
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#365 ‒ Training for longevity: A roundtable on building strength, preventing injury, meeting protein needs, guidance for women and youth athletes, and more | Gabrielle Lyon, Mike Boyle, Jeff Cavaliere
09/22/2025
#365 ‒ Training for longevity: A roundtable on building strength, preventing injury, meeting protein needs, guidance for women and youth athletes, and more | Gabrielle Lyon, Mike Boyle, Jeff Cavaliere
In this special episode of The Drive, Peter hosts a strength and conditioning roundtable with three experts in the field—Gabrielle Lyon, Jeff Cavaliere, and Mike Boyle. Together they explore why maintaining muscle mass, strength, and power is essential for healthspan and longevity, and examine how resistance training supports metabolic resilience and injury prevention across the lifespan. The conversation covers practical strategies for getting started and staying consistent, the importance of a protein-centered diet tailored to age and activity level, and approaches to resistance training for peri- and post-menopausal women—including tendon care and optimal programming. They debate single-leg training versus heavy bilateral lifts, share knee-friendly lower-body options, and highlight exercises that belong in the “graveyard” due to poor risk-reward ratios. Finally, the group discusses youth sports specialization, emphasizing the long-term value of variety for developing lifelong athletes. We discuss: Personal career journeys and philosophies of each guest that shaped their approaches to strength, conditioning, and lifelong health [3:30]; Why so few people engage in resistance training despite its proven health benefits [8:30]; Mike’s low-stress, high-consistency method for training beginners to resistance training [18:45]; How resistance training enhances metabolic health and body composition even in lean, highly active endurance athletes [25:30]; The dominant role of nutrition in shaping physique and achieving low body fat, the synergistic effect of resistance training, and the unrealistic expectations about muscle growth and fat loss [28:30]; Why Jeff advocates for five meals a day, and why meal timing matters less than overall protein intake and caloric consistency [38:00]; Optimizing protein for every stage of life: quality, quantity, and guidelines for diverse diets and body types [44:15]; The advantages of unilateral lower-body training over heavy bilateral lifts: impact on strength, athleticism, recovery, and functional movement [51:45]; Rethinking heavy squats and deadlifts: risk-reward, aging bodies, and the case for reverse lunges and other single-leg alternatives [1:01:15]; Adapting with age: Gabrielle on injuries, hip dysplasia, and the shift to smarter training [1:10:15]; Exercises that belong in the “iron graveyard”: unnecessarily risky exercises and their safer alternatives [1:19:15]; The downside of early sports specialization in children and the long-term benefits of encouraging kids to play multiple sports [1:25:00]; Advice for preventing an Achilles injury: calf strength, ankle mobility, and listening to pain signals [1:33:15]; Shoulder pain: how to keep training the upper body when shoulder pain limits pressing movements [1:40:45]; Effective strength training strategies for women before, during, and after the menopausal transition [1:43:15]; Best practices for strength training and athletic development in children, and the pitfalls of early sports specialization [1:50:30]; How to foster healthy habits and an interest in fitness beyond playing sports [2:00:00]; Something each guest has changed their mind about in the last five years [2:04:00]; and More. Connect With Peter on , , and
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#364 – AMA #75: Diets: how to evaluate and implement any diet including keto, carnivore, vegan, Mediterranean, and more
09/15/2025
#364 – AMA #75: Diets: how to evaluate and implement any diet including keto, carnivore, vegan, Mediterranean, and more
In this “Ask Me Anything” (AMA) episode, Peter explores how to determine the right diet for yourself rather than searching for a universal “best” diet. He begins by laying out five non-negotiable criteria that any sustainable eating pattern must meet—energy balance, metabolic health, adequate protein, micronutrient sufficiency, and long-term adherence—before introducing a practical rubric for evaluating different diets. Using this framework, Peter walks through the ketogenic, carnivore, vegan, and Mediterranean diets, highlighting their strengths, ideal candidates for each, and common pitfalls such as micronutrient gaps or adherence challenges. He explains why this guidance is aimed at people who feel overwhelmed by diet choices, not zealots defending a single approach, and provides practical advice on using tools like DEXA scans, lab markers, continuous glucose monitors, and symptom tracking to assess whether a diet is truly working. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Peter’s family chess battle [3:00]; Framing the diet discussion: moving past tribalism to practical frameworks for evaluating various dietary strategies [5:00]; Peter’s high-level nutrition framework [11:00]; Why diet is such a uniquely polarizing subject [14:15]; The five non-negotiables that apply to any diet [17:45]; How to think about energy balance in the context of evaluating a specific diet [20:15]; How diet can address metabolic health [21:45]; Protein as a dietary foundation [23:30]; Micronutrient essentials: avoiding deficiencies in restrictive and processed diets [24:45]; Why adherence and sustainability are essential for diet success [27:15]; Examining the standard American diet through the five non-negotiables [31:00]; The evaluation framework for specific diets [33:30]; The ketogenic diet: defining ketosis, clinical origins, modern uses, and potential health benefits [35:00]; The main strengths and weaknesses of the ketogenic diet [43:00]; How to avoid micronutrient deficiencies while on a ketogenic diet [47:15]; Electrolytes and fiber and the ketogenic diet: preventing magnesium loss and maintaining digestive health [49:15]; Adherence challenges of the ketogenic diet [51:30]; The carnivore diet: definition, motivations, anecdotal benefits, and possible mechanisms [53:15]; The main strengths and weaknesses of the carnivore diet [57:30]; Plant exclusion on the carnivore diet: nutrient gaps, gut changes, and unanswered questions [1:03:15]; Adherence challenges of the carnivore diet [1:04:45]; The vegan diet: definition, core beliefs, and various motivations for this strategy [1:05:45]; The main strengths and weaknesses of the vegan diet [1:09:15]; Adherence to the vegan diet: social acceptance, edge cases, and personal sustainability [1:13:15]; The Mediterranean diet: definitional challenges, traditional patterns, and its relatively strong evidence base [1:15:15]; Limitations of the Mediterranean diet: loose definitions and indulgence risks [1:19:30]; Measuring diet success: why setting clear goals and tracking outcomes matter [1:21:00]; Tracking body composition using DEXA scans [1:22:15]; Tracking metabolic health: key blood tests and advanced glucose monitoring tools [1:22:45]; Using elimination diets to identify food sensitivities that may cause digestive problems, autoimmune symptoms, or low energy [1:23:30]; Evaluating “anti-inflammatory diets”: confirming inflammation through symptoms and hs-CRP testing [1:25:15]; Final takeaways: flexibility, structure, and avoiding dogma in dietary choices [1:27:00]; and More. Connect With Peter on , , and
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#363 ‒ A new frontier in neurosurgery: restoring brain function with brain-computer interfaces, advancing glioblastoma care, and new hope for devastating brain diseases | Edward Chang, M.D.
09/08/2025
#363 ‒ A new frontier in neurosurgery: restoring brain function with brain-computer interfaces, advancing glioblastoma care, and new hope for devastating brain diseases | Edward Chang, M.D.
Edward Chang is a neurosurgeon, scientist, and a pioneering leader in functional neurosurgery and brain-computer interface technology, whose work spans the operating room, the research lab, and the engineering bench to restore speech and movement for patients who have lost these capabilities. In this episode, Edward explains the evolution of modern neurosurgery and its dramatic reduction in collateral damage, the experience of awake brain surgery, real-time mapping to protect critical functions, and the split-second decisions surgeons make. He also discusses breakthroughs in brain-computer interfaces and functional electrical stimulation systems, strategies for improving outcomes in glioblastoma, and his vision for slimmer, safer implants that could turn devastating conditions like ALS, spinal cord injury, and aggressive brain tumors into more manageable chronic illnesses. We discuss: The evolution of neurosurgery and the shift toward minimally invasive techniques [2:30]; Glioblastomas: biology, current treatments, and emerging strategies to overcome its challenges [10:45]; How brain mapping has advanced from preserving function during surgery to revealing how neurons encode language and cognition [16:30]; How awake brain surgery is performed [22:00]; How brain redundancy and plasticity allow some regions to be safely resected, the role of the corpus callosum in epilepsy surgery, and the clinical and philosophical implications of disconnecting the hemispheres [26:15]; How neural engineering may restore lost functions in neurodegenerative disease, how thought mapping varies across individuals, and how sensory decline contributes to cognitive aging [39:15]; Brain–computer interfaces explained: EEG vs. ECoG vs. single-cell electrodes and their trade-offs [48:30]; Edward’s clinical trial using ECoG to restore speech to a stroke patient [1:01:00]; How a stroke patient regained speech through brain–computer interfaces: training, AI decoding, and the path to scalable technology [1:10:45]; Using brain-computer interfaces to restore breathing, movement, and broader function in ALS patients [1:28:15]; The 2030 outlook for brain–computer interfaces [1:34:00]; The potential of stem cell and cell-based therapies for regenerating lost brain function [1:38:00]; Edward’s vision for how neurosurgery and treatments for glioblastoma, Parkinson’s disease, and Alzheimer’s disease may evolve by 2040 [1:42:15]; The rare but dangerous risk of vertebral artery dissections from chiropractic neck adjustments and high-velocity movements [1:44:45]; How Harvey Cushing might view modern neurosurgery, and how the field has shifted from damage avoidance to unlocking the brain’s functions [1:46:15]; and More. Connect With Peter on , , and
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Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D. (#287 rebroadcast)
09/01/2025
Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D. (#287 rebroadcast)
Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine. We discuss: Peter’s experience with debilitating back pain [3:00]; Anatomy of the back: spine, discs, facet joints, and common pain points [14:15]; Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:30]; Why the majority of back injuries happen around the L4, L5, and S1 joints [30:45]; How the spine responds to forces like bending and loading, and how it adapts to different athletic activities [36:00]; The pathology of bulging discs [43:00]; The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [45:45]; The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:00]; The significance of strength and stability in preventing injuries and preserving longevity [1:08:00]; Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:15]; Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:29:45]; Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:38:30]; When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:30]; Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:15]; Tarlov cysts: treatment and surgical considerations [2:00:00]; The evolution of patient assessments and the limitations of MRI [2:02:00]; Pain relief related to stiffness and muscle bulk through training [2:06:45]; Advice for the young person on how to keep a healthy spine [2:14:00]; Resources for individuals dealing with lower back pain [2:25:15]; and More. Connect With Peter on , , and
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#362 ‒ Understanding anxiety: defining, assessing, and treating health anxiety, OCD, and the spectrum of anxiety disorders | Josh Spitalnick, Ph.D., A.B.P.P.
08/25/2025
#362 ‒ Understanding anxiety: defining, assessing, and treating health anxiety, OCD, and the spectrum of anxiety disorders | Josh Spitalnick, Ph.D., A.B.P.P.
Josh Spitalnick is a clinical and research psychologist with expertise in treating a variety of anxiety conditions with cognitive-behavioral therapy (CBT) and other evidence-based approaches. In this episode, Josh unpacks the four layers of anxiety—psychological, emotional, cognitive, and behavioral—highlighting why avoidance is the key feature that transforms ordinary worry into disorder. He explains why he continues to treat OCD and PTSD as anxiety conditions despite their DSM-5 reclassification, and he draws important distinctions between worries versus worrying and thoughts versus thinking. The discussion explores health anxiety, illness anxiety, and the impact of modern contributors such as wearables, social media, and the COVID era, while weaving in real-world case studies and Josh’s structured assessment approach. Josh also breaks down evidence-based treatments, from exposure therapy and cognitive-behavioral therapy (CBT) to acceptance and commitment therapy (ACT), along with the role of medication, lifestyle factors, and how shifting from avoidance to committed action can build long-term resilience. We discuss: Josh’s professional background and his holistic approach to treating anxiety [3:00]; Definition of anxiety and changes in the DSM-5 [5:00]; The psychological and cognitive aspects of anxiety [10:45]; Breaking down anxiety symptoms: triggers, fears, and hidden mental rituals [17:00]; Thoughts versus thinking and worries versus worrying: what constitutes dysfunction [20:15]; Health anxiety and the limits of medical reassurance: understanding illness anxiety and somatic symptom disorder [24:30]; Triggering events for health anxiety, symptom fixation, heritability, and the role of nature versus nurture [36:30]; Historical and modern shifts in health anxiety, from HIV/AIDS in the 1980s to today’s heightened fears of cancer [45:30]; Modern factors and recent events that have amplified societal anxiety levels [47:15]; Josh’s approach to patients with excessive health-related rituals and/or OCD using CBT and exposure therapy [54:30]; Hypothetical example of treating a person with a fear of flying: assessment, panic disorder, and the role of medication and exposure therapy [1:03:15]; The four types of exposure therapy and the shift from habituation to inhibitory learning [1:14:00]; Treating people with OCD that manifests in disturbing and intrusive thoughts, and why therapy focuses on values over reassurance [1:21:00]; Acceptance and commitment therapy (ACT): reorienting patients toward values-driven living rather than symptom elimination [1:31:45]; Mindfulness as a tool to cultivate presence, awareness, and healthy engagement with life [1:36:30]; Hallmarks of successful therapy and red-flags that therapy is not going well [1:38:15]; The relationship between anxiety and substance use, and the therapeutic challenges it creates [1:44:45]; Anxiety’s overlap with ADHD, OCD, autism, and physical health conditions [1:49:45]; Debunking the harmful myth that health anxiety is a “made up” condition [1:51:30]; Prevalence, severity, and evolving treatments for health anxiety and OCD [1:54:45]; Treating health anxiety is about providing patients with skills to improve quality of life—a discussion on how to address symptoms often attributed to long COVID [2:01:30]; Balancing the benefits of abundant health information with the risks of fueling health anxiety [2:06:30]; Advice for finding a telehealth provider with expertise in health anxiety [2:11:00]; and More. Connect With Peter on , , and
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#361 - AMA #74: Sugar and sugar substitutes: weight control, metabolic effects, and health trade-offs
08/18/2025
#361 - AMA #74: Sugar and sugar substitutes: weight control, metabolic effects, and health trade-offs
In this “Ask Me Anything” (AMA) episode, Peter explains how to evaluate sugar and its substitutes in the context of health. Peter explores the role of sweeteners in three common use-cases – beverages, protein supplements, and sweet treats – and breaks down how our evolutionary craving for sweetness now clashes with today’s food environment. He examines whether sugar is uniquely fattening, the hormonal effects of sugar consumption, and the significance of timing in sugar intake. The episode compares natural versus refined sugars, sugar in beverages versus in solid foods, and the pros and cons of popular sweeteners including saccharin, aspartame, sucralose, allulose, and sugar alcohols like erythritol and xylitol. With a focus on weight management, glycemic impact, gut health, and long-term safety, this episode offers a comprehensive guide to navigating the sweetener landscape with clarity and nuance. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: A quick tangent on chess and parenting [2:30]; Overview of key scenarios for evaluating sugar and sweeteners [6:15]; Why humans are hardwired to crave sweetness [13:30]; Evaluating whether sugar is uniquely fattening or more harmful than other macronutrients under isocaloric conditions [15:15]; Why sugar drives appetite: low satiety, insulin response, and reward system activation [18:45]; How sugar type, liquid vs. solid form, and processing level influence appetite and metabolic impact [20:15]; Addressing the common belief that natural sugars are healthier than refined sugars [26:00]; How the timing of sugar consumption alters the body’s metabolic response [29:15]; How Peter advises patients on sugar intake, factoring in metabolic health, insulin sensitivity, and activity level [34:45]; The most common sugar substitutes, their sweetness relative to sugar, and their caloric content [36:30]; Evaluating the role of sugar substitutes in weight control: efficacy vs. effectiveness and limitations in study design [40:15]; Assessing the real-world impact of sugar substitutes on weight, and the role of sweetness without calories [44:00]; The impact of sugar substitutes on glycemic control [47:30]; Are microbiome changes from artificial sweeteners substantial enough to cause obesity and diabetes? [50:30]; How Peter advises patients on the use of sugar substitutes across different contexts [52:30]; Allulose—a sweetener with unique satiety and glycemic benefits and potential for weight control [57:15]; Emerging evidence that stevia, monk fruit, and sugar alcohols may provide modest metabolic benefits compared to sugar [1:03:00]; Sugar alcohols explained [1:04:15]; Sugar alcohols and GI issues [1:05:00]; Xylitol’s dental health benefits and considerations for use [1:06:30]; Artificial sweeteners and cancer risk: evaluating evidence, the aspartame controversy, and the role of dose in toxicology [1:07:15]; Sugar substitutes and cardiovascular disease: assessing flawed studies and the absence of direct risk evidence [1:11:00]; Why artificial sweeteners seem to attract so many negative headlines [1:12:45]; Balancing benefits and risks of sugar substitutes: guidance for desserts, beverages, and protein products [1:14:15]; and More. Connect With Peter on , , and
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#360 ‒ How to change your habits: why they form and how to build or break them | Charles Duhigg, M.B.A
08/11/2025
#360 ‒ How to change your habits: why they form and how to build or break them | Charles Duhigg, M.B.A
Charles Duhigg is a Pulitzer Prize-winning journalist and best-selling author known for distilling complex neuroscience and psychology into practical strategies for behavior change, performance, and decision-making. In this episode, Charles explores the neuroscience behind habit formation, including how cue-routine-reward loops drive nearly half of our daily actions and why positive reinforcement is far more effective than punishment. He explains how institutions like the military and Alcoholics Anonymous engineer environments to change behavior at scale, as well as discussing the limits of willpower and how to preserve it by shaping context. The conversation also covers the real timeline of habit formation, how to teach better habits to kids, the role of failure and self-compassion in lasting change, and the power of social accountability. Charles further discusses how cognitive routines enhance productivity and creativity, how to gamify long-term goals through immediate rewards, why identity and purpose are often the strongest forces behind sustainable behavior change, and the potential of AI to power habit change. We discuss: How Charles’s background in journalism and personal experiences led to his interest in habit formation [3:15]; The science behind reinforcement: why positive rewards outperform punishment in habit formation [10:15]; How the military uses habit science to train soldiers using cues, routines, and rewards [17:15]; Methods for creating good habits and eliminating bad ones: environmental control, small wins, rewards-based motivation, and more [24:00]; How parents can teach kids to build habits and strengthen willpower [32:15]; How adults experience changes in motivation and cue effectiveness over time, and why willpower must be managed like a finite resource [34:30]; Keys to successful habit change: planning for relapse, learning from failure, and leveraging social support [38:00]; Advice for parents: praise effort, model habits, and normalize failure [47:45]; The time required for making or breaking a habit [50:45]; The different strategies for creating new habits vs. changing existing ones, and the crucial role of cues and reward timing [55:15]; How to create habits around long-term goals when the rewards are delayed (like saving money) [1:01:45]; How to stick with good habits that offer no immediate reward: designing reinforcements and identity-based motivation [1:11:15]; The potential for AI to provide social reinforcement [1:16:45]; Mental habits: how thought patterns and contemplative routines shape deep thinking, innovation, and high-stakes performance [1:23:30]; How cognitive routines boost productivity and habit formation but may stifle creativity [1:35:15]; Contemplative routines: using stillness to unlock deeper productivity and creativity [1:40:45]; How habits reduce decision fatigue and enable deep, high-quality productivity [1:44:15]; New research that reveals the power of environment and social feedback in habit formation [1:49:45]; How AI may transform work, identity, and our sense of purpose [1:53:45]; The potential of AI-powered habit change, and the essential—but often lacking—element of motivation [2:02:30]; and More. Connect With Peter on , , and
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#359 ‒ How metabolic and immune system dysfunction drive the aging process, the role of NAD, promising interventions, aging clocks, and more | Eric Verdin, M.D.
08/04/2025
#359 ‒ How metabolic and immune system dysfunction drive the aging process, the role of NAD, promising interventions, aging clocks, and more | Eric Verdin, M.D.
Eric Verdin is a physician-scientist and the CEO of the Buck Institute for Research on Aging whose career has centered on understanding how epigenetics, metabolism, and the immune system influence the aging process. In this episode, Eric traces his scientific journey from studying viruses and histone deacetylases (HDACs) to leading aging research at the Buck Institute, offering insights into how aging impairs immune and nervous system function—including thymic shrinkage, chronic inflammation, and reduced vaccine response—and how these changes impact lifespan. He explores the metabolic underpinnings of aging, such as oxidative stress and insulin and IGF-1 signaling, and he discusses practical tools like zone 2 cardio, ketogenic diets, and GLP-1 drugs. The conversation also covers declining NAD levels with age, the roles of NAD-consuming enzymes such as sirtuins and CD38, and what current NAD-boosting strategies (like NMN, NR, and IV NAD) can and can’t accomplish. Eric weighs in on promising longevity interventions including rapamycin, growth hormone for thymic regeneration, and anti-inflammatory therapies, while also examining the promise and limitations of current biological age tests and the potential of combining epigenetic, proteomic, and organ-specific metrics with wearables to guide personalized longevity care. We discuss: Eric’s scientific journey from virology to the field of geroscience [2:45]; How dysfunction in the immune system and central nervous system can drive aging throughout the body [5:00]; The role of metabolism and oxidative stress in aging, and why antioxidant strategies have failed to deliver clear benefits [8:45]; Other aspects of metabolism linked to aging: mitochondrial efficiency, fuel utilization, and glucose-modulating drugs [16:30]; How inefficient glucose metabolism drives insulin, IGF-1 signaling, and accelerates aging [21:45]; The metabolic effects of GLP-1 agonists, and the need to move beyond crude metrics like BMI in favor of more precise assessments of metabolic health [27:00]; The case for immune health as a “fifth horseman” [36:00]; How the innate and adaptive immune systems work together to build immune memory [39:45]; Why vaccines lose effectiveness with age: shrinking of the thymus gland and diminished T-cell diversity [44:15]; Exploring growth hormone, thymic regeneration, and the role of exercise in slowing immune aging [48:45]; The challenges of identifying reliable biomarkers for immune function, and the potential of rapamycin analogs to enhance vaccine response in older adults [57:45]; How rapamycin’s effects on the immune system vary dramatically by dosage and frequency [1:03:30]; The limitations of mouse models in aging research and the need for cautious interpretation of rapamycin’s benefits in humans [1:08:15]; NAD, sirtuins, and aging: scientific promise amid commercial hype [1:15:45]; How CD38 drives age-related NAD decline, influences immune function, and may impact longevity [1:23:45]; How NMN and NR supplementation interact with CD38 and NAD metabolism, and potential risks like homocysteine elevation and one-carbon cycle depletion [1:31:00]; Intravenous NAD: limited evidence and serious risks [1:37:00]; Interleukin-11 (IL-11) as a new target in immune aging, the dual role of chronic inflammation in aging, and the need for better biomarkers to guide interventions [1:43:00]; Biological aging clocks: types of clocks, promise, major limitations, and future outlook [1:48:30]; The potential of proteomics-based aging clocks for detecting organ-specific decline and frailty [2:00:45]; and More. Connect With Peter on , , and
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#358 ‒ Peter’s takeaways on navigating HRT, rejuvenating the face, understanding the biology of aging, optimizing fertility, and learning to live well from the dying | Quarterly Podcast Summary #6
07/28/2025
#358 ‒ Peter’s takeaways on navigating HRT, rejuvenating the face, understanding the biology of aging, optimizing fertility, and learning to live well from the dying | Quarterly Podcast Summary #6
In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions with Paul Turek and Paula Amato on male and female fertility; Rachel Rubin on menopause and hormone replacement therapy; Brian Kennedy on the biology of aging; Tanuj Nakra and Suzan Obagi on facial aging and skin rejuvenation; and BJ Miller and Bridget Sumser on lessons we can learn from the dying about how to live. Peter highlights the most important insights from each episode and any behavioral changes he’s made for himself or his patients as a result of these fascinating discussions. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Summary of episode topics [1:15]; Episodes on fertility with Paul Turek and Paula Amato: insights on all things male and female fertility [4:45]; How men can optimize fertility [20:15]; How women can optimize fertility [26:00]; Rachel Rubin episode: insights on women’s sexual health, menopause, and HRT [31:45]; How women can prepare for menopause: proactive care, evidence-based HRT, and more [41:45]; Brian Kennedy episode: understanding aging, role of inflammation and mTOR, and current limitations of aging clocks and biomarkers [46:30]; Advice from Brian Kennedy on testing longevity interventions [56:45]; Tanuj Nakra/Suzan Obagi episode: causes of facial aging and practical strategies for prevention and treatment [57:30]; Skincare: making sense of the wide range of skin resurfacing treatments [1:06:45]; How to create a realistic, sustainable skincare routine [1:12:30]; The dangers of following unqualified aesthetic advice online and the importance of getting professional medical guidance for cosmetic treatments [1:18:00]; BJ Miller/Bridget Sumser episode: lessons about living from the dying [1:21:45]; and More. Connect With Peter on , , and
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#357 ‒ A new era of longevity science: models of aging, human trials of rapamycin, biological clocks, promising compounds, and lifestyle interventions | Brian Kennedy, Ph.D.
07/21/2025
#357 ‒ A new era of longevity science: models of aging, human trials of rapamycin, biological clocks, promising compounds, and lifestyle interventions | Brian Kennedy, Ph.D.
Brian Kennedy is a renowned biologist, leader in aging research, and director of the Center for Healthy Longevity at the National University of Singapore. In this episode, Brian shares insights from ongoing human aging studies, including clinical trials of rapamycin and how dosing strategies, timing, and exercise may influence outcomes. He presents two key models of aging—one as a linear accumulation of biological decline and the other as an exponential rise in mortality risk—and explains why traditional models of aging fall short. He also explains why most current aging biomarkers lack clinical utility and describes how his team is working to develop a more actionable biological clock. Additional topics include the potential of compounds like alpha-ketoglutarate, urolithin A, and NAD boosters, along with how lifestyle interventions—such as VO2 max training, strength building, and the use of GLP-1 and SGLT2 drugs—may contribute to longer, healthier lives. We discuss: Brian’s journey from the Buck Institute to Singapore, and the global evolution of aging research [2:45]; Rethinking the biology of aging: why models like the hallmarks of aging fall short [9:45]; How inflammation and mTOR signaling may play a central, causal role in aging [14:15]; The biological role of mTOR in aging, and the potential of rapamycin to slow aging and enhance immune resilience [17:30]; Aging as a linear decline in resilience overlaid with non-linear health fluctuations [22:30]; Speculating on the future of longevity: slowing biological aging through noise reduction and reprogramming [33:30]; Evaluating the role of the epigenome in aging, and the limits of methylation clocks [39:00]; Balancing the quest for immortality with the urgent need to improve late-life healthspan [43:00]; Comparing the big 4 chronic diseases: which are the most inevitable and modifiable? [47:15]; Exploring potential benefits of rapamycin: how Brian is testing this and other interventions in humans [51:45]; Testing alpha-ketoglutarate (AKG) for healthspan benefits in aging [1:01:45]; Exploring urolithin A’s potential to enhance mitochondrial health, reduce frailty, and slow aging [1:05:30]; The potential of sublingual NAD for longevity, and the combination of NAD and AKG for metabolic and exercise enhancement [1:09:00]; Other interventions that may promote longevity: spermidine, 17𝛼-estradiol, HRT, and more [1:17:00]; Biological aging clocks, clinical biomarkers, and a new path to proactive longevity care [1:23:15]; Evaluating rapamycin, metformin, and GLP-1s for longevity in healthy individuals [1:32:15]; Why muscle, strength, and fitness are the strongest predictors of healthspan [1:37:30]; Why combining too many longevity interventions may backfire [1:39:30]; How increased funding and AI integration could accelerate breakthroughs in aging research [1:41:45]; The research Brian is most excited about, and the need to balance innovation with safety in longevity clinics [1:47:00]; Peter’s reflections on emerging interventions and the promise of combining proven aging compounds [1:54:00]; and More. Connect With Peter on , , and
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#356 - AMA #73: Preserving brain health, optimizing exercise programming, improving body composition, and more
07/14/2025
#356 - AMA #73: Preserving brain health, optimizing exercise programming, improving body composition, and more
In this “Ask Me Anything” (AMA) episode, Peter addresses frequently requested topics, including brain health, exercise programming, and body composition. He explores the factors that influence dementia risk—including metabolic health, fitness, sleep, hearing, cholesterol levels, and more. He explains how to implement zone 2 training and VO₂ max intervals for cardiovascular fitness and also covers how to combine cardio modalities, how to stay in zone 2, and special considerations for women. Peter highlights the benefits of light movement after meals and offers strength training tips for those managing injuries. Additional insights include how to maintain fat loss, the truth about so-called “slow metabolisms,” and how to set appropriate daily protein goals while managing the trade-off between lean mass and body fat over time. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Overview of episode topics on brain health, cardiovascular training strategies, and body composition [2:15]; Understanding dementia risk: modifiable vs. non-modifiable contributors to cognitive decline [5:00]; The causality between metabolic health and dementia [9:45]; How diet and exercise influence brain health: energy balance and exercise as key preventative tools [13:30]; Why combining aerobic, resistance, and cognitively engaging activities offers the most comprehensive benefits for preventing cognitive decline [17:00]; Additional lifestyle factors that influence dementia risk: smoking, head trauma, alcohol, and sleep [19:45]; The link between hearing loss and dementia: dose-dependent risk and the case for correction [25:15]; How poor oral hygiene may contribute to neuroinflammation and dementia risk [27:30]; Supplements for brain health: which ones matter and when they’re worth considering [28:45]; Low LDL cholesterol and brain health: debunking the myth of cognitive risk [33:45]; How to approach zone 2 training: the importance of staying in zone 2 and tailoring intensity based on your time and goals [38:00]; Lactate testing for zone 2: clinical protocols and at-home approaches [43:00]; Combining modalities in zone 2 training: balancing enjoyment and efficiency [47:00]; Zone 2 training for women: addressing the misconception that zone 2 training is unnecessary or ineffective for postmenopausal women [49:30]; Effective strategies for VO₂ max training: short vs. long intervals [51:45]; The benefits of post-meal walking for glucose management, and why spikes in glucose during exercise aren’t harmful [56:45]; The role of stability training in supporting resistance work and healthy aging [1:00:15]; Adapting strength training to manage chronic back injuries and train for longevity [1:02:00]; The role of aerobic exercise (like zone 2) in fat loss, metabolic health, and weight maintenance [1:06:30]; Debunking the “fast vs. slow metabolism” myth: why energy balance and protein matter most for fat loss [1:09:45]; Lean mass vs. body fat: why both matter for health and longevity [1:12:15]; How protein intake impacts muscle mass and why pairing it with resistance training is significantly more effective [1:15:15]; and More. Connect With Peter on , , and
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Navigating bone health: early life influences and advanced strategies for improvement and injury prevention (#214 rebroadcast)
07/07/2025
Navigating bone health: early life influences and advanced strategies for improvement and injury prevention (#214 rebroadcast)
In this episode from July 2022, Peter dives deep into the topic of bone health and explains why this is an important topic for everyone, from children to the elderly. He begins with an overview of bone mineral density, how it’s measured, how it changes over the course of life, and the variability between sexes largely due to changes in estrogen levels. From there he provides insights into ways that one can improve bone health, from exercise to nutrition supplements to drugs. Additionally, Peter discusses what happens when one may be forced to be sedentary (e.g., bedrest) and how you can work to minimize the damage during these periods. While this original episode is an AMA, it is available in full to all listeners as a special rebroadcast. We discuss: Overview of bone health topics to be discussed [2:30]; Bones 101: bone function, structure, and more [6:15]; Bone mineral density (BMD), minerals in bone, role of osteoblasts and osteoclasts, and more [9:30]; The consequences of poor bone health [14:30]; The devastating nature of hip fractures: morbidity and mortality data [18:00]; Where fractures tend to occur in the body [23:45]; Defining osteopenia and osteoporosis [25:30]; Measuring BMD with DEXA and how to interpret scores [28:00]; Variability in BMD between sexes [35:15]; When should people have their first bone mineral density scan? [37:45]; How BMD changes throughout the life and how it differs between men and women [40:15]; How changes in estrogen levels (e.g., menopause) impact bone health [45:15]; Why HRT is not considered a standard of care for postmenopausal bone loss [49:00]; Factors determining who may be at higher risk of poor bone health [52:00]; Common drugs that can negatively impact BMD [55:45]; How children can optimize bone health and lay the foundation for the future [59:30]; Types of physical activity that can positively impact bone health [1:03:30]; How weight loss can negatively impact bone health and how exercise can counteract those effects [1:12:15]; Nutrition and supplements for bone health [1:16:00]; Pharmaceutical drugs prescribed for those with low BMD [1:18:45]; Impact of extreme sedentary periods (e.g., bedrest) and how to minimize their damage to bone [1:23:30]; and More. Connect With Peter on , , and
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#355 – Skincare strategies, the science of facial aging, and cosmetic-intervention guidance | Tanuj Nakra, M.D. & Suzan Obagi, M.D.
06/30/2025
#355 – Skincare strategies, the science of facial aging, and cosmetic-intervention guidance | Tanuj Nakra, M.D. & Suzan Obagi, M.D.
Tanuj Nakra and Suzan Obagi, two leading experts in aesthetic medicine, join Peter to explore the science of facial aging and skin health as well as the responsibilities physicians face in the world of cosmetic procedures. In this episode, they examine the biological and hormonal drivers of facial aging, the evolutionary and psychological foundations of attractiveness, and the impact of modern media on beauty standards. They discuss the rise in cosmetic procedures among adolescents and the ethical responsibilities of physicians in these cases. The conversation then shifts to a practical, evidence-based guide to skin health—covering the use of mineral sunscreens, retinoids, vitamin C, and tailored skincare routines, as well as the management of acne and the psychology behind aesthetic consultations. The episode culminates in a candid, personal assessment of Peter’s own face, offering a revealing look at what aesthetic medicine can achieve and how to think critically about pursuing it. We discuss: Tanuj’s and Suzan’s training and expertise, and the evolving field of aesthetic medicine [4:00]; The biology of the aging face [10:45]; Why facial fat atrophies with age while body fat tends to accumulate [17:00]; How chronic stress accelerates facial aging [20:30]; The evolutionary biology of beauty, and how modern lifestyle, culture, and medicine interact with these ancient aesthetic instincts [25:30]; How social media and influencers have rapidly shifted aesthetic trends toward exaggerated features and unrealistic beauty standards [36:45]; The ethical challenges, financial incentives, and social pressures shaping modern aesthetic medicine [42:00]; The concerning trend of teenagers seeking cosmetic enhancements: the ethical and cultural impact of early beauty pressure [51:45]; Protecting the skin: UV damage and sunscreen recommendations [58:15]; Strategies for minimizing skin aging: retinoids, vitamin C, and evidence-based application methods [1:09:00]; Effective daily skincare routine: cleansing, antioxidants, retinoids, moisturization, and more [1:18:45]; The playbook for managing acne [1:31:00]; The 4 changes of aging and the complexities of aesthetic consultations including the anatomical, psychological, and ethical factors physicians must navigate [1:39:00]; The 5 R’s of rejuvenation [1:50:15]; A facial aging analysis and cosmetic strategy using Peter’s face as a real-time case study [1:53:00]; The decision-making process between fat grafting and dermal fillers for facial rejuvenation [1:56:30]; How self-image, eye aesthetics, and fleeting photos drive the desire for cosmetic enhancement [2:01:45]; Advice for wrinkles, causes of dark circles under the eyes, and the importance of facial symmetry [2:05:45]; Considerations that shape clinical decision making around fat grafting and other procedures to address the eye area [2:11:00]; The evolution of facial cosmetic surgery techniques, the serious risks involved, and how physician skill and procedure selection greatly impact outcomes [2:21:30]; How patients can make informed and safe choices when selecting a cosmetic surgeon [2:27:15]; A comparison of ablative versus non-ablative skin resurfacing treatments, laser vs. peels, and more [2:38:45]; How treatments are chosen and customized based on patient-specific factors [2:48:00]; The lifelong human desire to align physical appearance with self-identity [2:52:45]; and More. Connect With Peter on , , and
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#354 – What the dying can teach us about living well: lessons on life and reflections on mortality | BJ Miller, M.D. and Bridget Sumser, L.C.S.W.
06/23/2025
#354 – What the dying can teach us about living well: lessons on life and reflections on mortality | BJ Miller, M.D. and Bridget Sumser, L.C.S.W.
BJ Miller, a hospice and palliative care physician, and Bridget Sumser, a licensed social worker specializing in serious illness and end-of-life care, join Peter to share insights from their decades of work supporting people at the end of life. In this episode, they explore the emotional and physiological processes of dying, the cultural barriers that prevent meaningful conversations about death, and how early engagement with mortality can lead to greater clarity and connection. The conversation highlights the distinctions between hospice and palliative care, the nature of suffering beyond physical pain, and the transformative role of honesty, forgiveness, and relational awareness in the dying process. Through stories and reflections, BJ and Bridget reveal what truly matters in the end—and how the dying can teach the living not only how to face death but how to live more fully. We discuss: The personal journeys of BJ and Bridget into end-of-life care, and the connection between living and dying [3:30]; What dying looks like: the physical, cognitive, and emotional realities at the end of life [13:15]; How historical perspectives on death contrast with modern experiences of dying [25:30]; The difference between palliative care and hospice care [30:45]; The systemic challenges surrounding hospice care: why patients often enter it too late to receive its full benefits [35:30]; How delayed hospice referrals and unspoken preferences often prevent patients from dying where and how they truly want [39:30]; The realities of home hospice: challenges, costs, and burdens placed of families [43:45]; How proactively engaging with the reality of death can avoid unnecessary suffering and promote a more peaceful ending [53:30]; How palliative care is misunderstood and underutilized—especially in cancer care [1:02:45]; Palliative care in the case of Alzheimer’s disease: emotional support, future planning, and family involvement [1:12:15]; The importance of having an advance directive: defining what matters most before it’s too late [1:23:00]; The differences between how young and old individuals experience dying from cancer [1:30:15]; The difference between pain and suffering, role of medicine in pain relief, and why emotional healing is essential at the end of life [1:35:45]; Dying well: the power of self-honesty and human connection at the end of life [1:47:00]; How psychedelics like psilocybin can unlock emotional breakthroughs and deepen connection for patients near the end of life [1:55:15]; Lessons from the dying on how to live well [1:57:30]; The physical process of active dying, and the emotional and practical considerations for loved ones [2:09:30]; and More. Connect With Peter on , , and
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#353 - AMA #72: Fasting: benefits for body composition and disease prevention, potential risks, and Peter’s updated practical framework
06/16/2025
#353 - AMA #72: Fasting: benefits for body composition and disease prevention, potential risks, and Peter’s updated practical framework
In this “Ask Me Anything” (AMA) episode, Peter revisits the topic of fasting, sharing how his thinking has evolved over time. The episode explores fasting-related terminology and common types of fasting, as well as the various reasons individuals might choose to fast. Peter explores potential benefits including improvements in body composition, metabolic health, lifespan extension, cardiovascular disease, cancer prevention and treatment, neurodegenerative conditions such as Alzheimer’s and Parkinson’s, and autoimmune symptoms like arthritis. He also examines the risks and potential downsides of fasting and offers a practical framework to help assess when and how fasting may be most appropriately applied. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Why the topic of fasting is being revisited [1:45]; The importance of being open to changing one's opinion in science and medicine as new evidence emerges [4:15]; Defining fasting and how it fits in the framework of dietary restriction, time-restricted feeding, and calorie restriction [7:30]; The most common types of fasting [11:45]; Why someone might choose fasting over continuous caloric restriction [19:00]; The biochemical effects of fasting: fuel partitioning, autophagy, and more [21:00]; Autophagy: a cellular cleanup process stimulated by fasting and energy depletion [26:00]; Comparing the physiological effects of a ketogenic diet to those of long-term fasting [27:45]; How long fasting takes to induce ketosis and boost autophagy, and how autophagy is measured [29:45]; At-home tests for ketones [33:45]; Reducing senescent (“zombie”) cells and inflammation through autophagy [35:00]; Examining the evidence for the long-term health benefits of fasting beyond short-term metabolic effects [37:15]; The common health claims associated with fasting across metabolic, neurological, oncological, autoimmune, and longevity domains [40:30]; The impact of fasting on body weight and body composition [42:00]; Weight regain and potential metabolic consequences of fasting [44:00]; The risk of lean mass loss with fasting and how to mitigate it [47:15]; A practical framework for using fasting as a strategy to improve body composition [52:15]; How extended fasting compares to caloric restriction in improving insulin sensitivity in people with insulin resistance or type 2 diabetes [54:00]; Is there any evidence that fasting can extend lifespan? [55:45]; Examining whether fasting improves cardiovascular disease risk beyond the effects of weight loss and calorie reduction [58:15]; Exploring whether prolonged fasting can reduce cancer risk [59:45]; The potential benefits of fasting or fasting-mimicking diets during cancer treatment: emerging evidence and practical considerations [1:02:15]; Fasting for protection against neurodegenerative diseases: early evidence of therapeutic benefit and open questions [1:10:45]; Various fasting methods for autoimmune diseases: potential symptom relief with cautious application [1:14:00]; Fasting and type 1 diabetes: risks, evidence, and careful dietary alternatives [1:16:45]; Fasting and gut disorders: potential benefits outside of flare-ups [1:18:45]; The primary risks and downsides associated with fasting [1:19:45]; The essential vitamins and minerals to supplement during prolonged fasting [1:21:30]; Who should avoid fasting and why [1:22:15]; Fasting’s role in health: where it shows promise and where it likely offers no distinct advantage over caloric restriction [1:23:45]; and More. Connect With Peter on , , and
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#352 ‒ Female fertility: optimizing reproductive health, diagnosing and treating infertility and PCOS, and understanding the IVF process | Paula Amato, M.D.
06/09/2025
#352 ‒ Female fertility: optimizing reproductive health, diagnosing and treating infertility and PCOS, and understanding the IVF process | Paula Amato, M.D.
This is part two of a two-part mini-series on fertility and reproductive health. Paula Amato is a leading expert in female reproductive health and infertility, widely recognized for her contributions to advancing fertility treatment and research. In this episode, which follows last week's conversation on male fertility, Paula explores the biology of female fertility, including how hormonal changes regulate the menstrual cycle and ovulation, what those patterns reveal about fertility potential, and why both partners should be evaluated early in infertility workups. She discusses the role of the fallopian tubes, the causes of miscarriage, the impact of age and lifestyle on fertility, and treatment options for conditions like PCOS—including the emerging use of GLP-1 agonists. The episode also covers the evolution of IVF, advances in pre-implantation genetic testing, egg freezing, and the promise and limitations of next-generation reproductive technologies. We discuss: The finite nature of a woman’s egg reserve, how it changes over time, and the basic process of ovulation and fertilization [3:00]; How hormones influence egg selection, and how and why chromosomal errors lead to most miscarriages [5:30]; The full journey of conception—from hormonal cues triggering ovulation, to fertilization, embryo development, implantation, and early pregnancy risks [16:30]; How infertility is defined and diagnosed, and the broader trends contributing to rising infertility rates [25:15]; Fallopian tube damage: how STDs and scarring impact fertility and raise ectopic pregnancy risk [31:30]; Unexplained infertility: how doctors evaluate ovulation and cycles—and why more research on women’s health is needed [41:00]; The defining symptoms of polycystic ovary syndrome (PCOS), its hormonal characteristics, and its relationship with insulin resistance [44:00]; Managing PCOS without pregnancy: cycle regulation, androgen suppression, and insulin resistance treatment [46:00]; The treatment approach for women with PCOS who are trying to conceive: GLP-1 use, ovulation induction, and timing protocols [49:45]; Barriers to getting informed fertility care for PCOS: limited provider knowledge and access, insurance gaps, and next steps when ovulation treatments don’t lead to pregnancy [55:45]; Fertility treatment for women with unexplained infertility, risk of multiple pregnancies with superovulation, and more [1:03:00]; Intrauterine insemination (IUI): process, success rates, and when in vitro fertilization (IVF) becomes the better option [1:07:00]; The history of in vitro fertilization (IVF), and how access and acceptance have evolved over time [1:16:45]; The step-by-step process of IVF [1:19:30]; The IVF lab process: egg retrieval, fertilization, embryo culture, and freezing [1:26:30]; Genetic testing and embryo selection in IVF: aneuploidy screening, polygenic traits, and ethical concerns [1:41:15]; Embryo transfer in IVF: timing, uterine preparation, and implantation support [1:47:30]; Egg donation in IVF: indications, donor guidelines, and other considerations [1:50:45]; How to choose the right IVF clinic [1:54:45]; Innovations in fertility on the horizon, advice about freezing eggs, and more [2:02:00]; Optimizing fertility through lifestyle: diet, stress management, sleep, exercise, and supplementation [2:07:45]; Promising areas of fertility research [2:15:45]; and More. Connect With Peter on , , and
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#351 ‒ Male fertility: optimizing reproductive health, diagnosing and treating infertility, and navigating testosterone replacement therapy | Paul Turek, M.D.
06/02/2025
#351 ‒ Male fertility: optimizing reproductive health, diagnosing and treating infertility, and navigating testosterone replacement therapy | Paul Turek, M.D.
This is part one of a two-part mini-series on fertility and reproductive health, with next week's guest, Dr. Paula Amato, focusing on the female side of the equation. Paul Turek is a world-renowned expert in male fertility and reproductive health, the founder and medical director of the Turek Clinic, and host of the Talk with Turek podcast. In this episode, Paul explores the topic of male fertility, offering a detailed look at the complex and highly coordinated process of conception and the many challenges sperm face on their journey to fertilizing an egg. He shares fascinating insights into how sperm work together to navigate the female reproductive tract, how environmental factors like heat, stress, and toxins impact sperm quality, and what men can do to improve their reproductive health. Paul also dispels common myths about testosterone replacement therapy and its effects on fertility, providing strategies for preserving fertility while on TRT. The episode also highlights cutting-edge advances in reproductive medicine, from genetic testing and sperm sorting to emerging treatments for infertility. We discuss: The incredibly complex and hostile journey sperm must take to fertilize an egg [3:00]; How sperm are made: meiosis, genetic variation, and the continuous renewal influenced by environmental factors [9:00]; The built-in filter that weeds out genetically abnormal sperm [14:45]; How sperm are finalized in form and function: tail formation, energy storage, and chemical sensing abilities [18:30]; How to optimize conception through the timing of sex, ejaculation frequency, and understanding the sperm lifecycle [26:30]; Male infertility and Paul’s diagnostic approach: detailed history, a physical exam, and identifying red flags [33:30]; Viral infections that can affect the testes and potentially lead to sterility [40:30]; Semen analysis: morphology, motility, and hormonal clues to male fertility [45:45]; Effects of medication, microplastics, stress, and exercise on fertility [57:15]; Testosterone replacement therapy (TRT) and male fertility [1:06:00]; Restoring fertility after prolonged use of exogenous testosterone [1:25:00]; Effects of heat and cold exposure on fertility and sperm quality [1:36:00]; How different levels of exercise—especially cycling—affect male fertility [1:41:45]; How alcohol, marijuana, and nicotine affect male fertility [1:46:00]; Why type 2 diabetes is a risk factor for male infertility [1:50:00]; How varicoceles—a common cause of male infertility—are diagnosed and treated [1:51:15]; Genetic factors that affect fertility [1:54:00]; The impact of lifestyle and environmental exposures on fertility [1:56:30]; The evidence (or lack thereof) behind stem cell and PRP therapies for male infertility, and how lifestyle and non-invasive interventions often lead to successful conception [2:00:30]; Considerations for sperm banking, and how paternal age impacts fertility planning and offspring health [2:05:00]; Semen quality as a biomarker: linking male fertility, longevity, and preventative health through Medicine 3.0 and epigenetics [2:14:45]; and More. Connect With Peter on , , and
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#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
05/26/2025
#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.
Kyler Brown is a sports rehab chiropractor who specializes in injury recovery, pre- and post-surgical rehabilitation, and guiding clients from rehab back to peak performance. As co-founder of the private training program 10 Squared alongside Peter, Kyler shares his approach to injury prevention and performance optimization—highlighting how overlooked movement patterns can quietly lead to chronic issues over time. He outlines a practical framework for assessing and treating individuals, highlights the importance of understanding movement dynamics and asymmetries, and discusses personalized rehab strategies through real-world case studies. The conversation also explores the psychological side of recovery, including the role of fear and mental barriers in rehabilitation. Kyler shares actionable tools to evaluate movement patterns and implement training strategies that support long-term strength and health. A companion video series demonstrating exercises for common problem areas—such as the lower back, neck, shoulders, and knees—is available exclusively to subscribers on the show notes page. We discuss: The personalized rehab strategy for Peter’s shoulder surgery that sparked creation of a training program called 10 Squared [3:00]; Training for the marginal decade: why precision and purpose are essential for quality of life [11:00]; The Centenarian Decathlon: how training for long-term capacity enhances both current and future quality of life [18:00]; How the shortcomings of conventional rehab and performance systems led to the creation of 10 Squared, a personalized training model focused on long-term physical capacity and individualized care [23:45]; Case study: how personalized assessment and treatment at 10 Squared helps uncover the root causes of injuries [31:00]; The role of the “core” in movement and injury prevention, and the importance of training stability before strength [40:15]; The layered assessment process used at 10 Squared to determine whether a person is ready to perform dynamic movements [47:45]; Case study: the rehab plan designed to treat a hamstring injury while preserving fitness and preventing reinjury [51:45]; Training approach for clients with minimal training history: risk reduction, habit-building, and long-term consistency [55:30]; How to train foot reactivity, tendon resilience, and explosive capacity in a safe, progressive way [1:00:00]; Peter’s foot and ankle pain: how to diagnose, treat, and strengthen the lower extremities [1:04:15]; How fear and perception influence recovery, what drives back pain, and when to choose surgery vs. treatment [1:13:15]; Could AI and app technology eventually deliver an individualized rehab and training experience? [1:22:30]; Kyler’s professional evolution from traditional chiropractic care to a degree-agnostic, performance-based rehab philosophy [1:25:00]; How 10 Squared provides precision rehab and training in a remote format [1:30:30]; How Peter resolved a severe back pain flare-up using DNS-guided isometric exercise instead of passive treatments [1:33:15]; How to identify and treat common joint pain (neck, back, knee, shoulder) using a rehab framework that strengthens supporting structures and helps avoid surgery [1:39:00]; and More. Connect With Peter on , , and
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#349 - AMA #71: Building strength and muscle mass: how to optimize training, nutrition, and more for longevity
05/19/2025
#349 - AMA #71: Building strength and muscle mass: how to optimize training, nutrition, and more for longevity
In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of muscle mass and strength, examining their essential roles in both lifespan and healthspan. Drawing from over 30 hours of prior discussions with experts including Layne Norton, Andy Galpin, and Mike Israetel, this episode distills the most important insights into one comprehensive and up-to-date conversation. Peter explores why muscle matters for longevity, metabolic health, and injury prevention, and clarifies the differences between muscle mass and strength, including which is more vital for aging well. He breaks down practical strategies for building muscle safely and effectively, including progressive overload, training intensity, rep ranges, and the importance of explosive power. Peter also covers key nutrition strategies—like protein intake, timing, and creatine supplementation—and offers practical advice for everyone from beginners to seasoned lifters on building and maintaining muscle safely and sustainably. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Peter’s humorous experience talking nutrition with a second grader [2:30]; Overview of topics, episode structure, and reasoning for focus on muscle mass and strength [6:00]; Defining key terms: muscle mass, strength, hypertrophy, power, and more [8:15]; The importance of muscular strength, muscle mass, and cardiorespiratory fitness for longevity [10:30]; Grip strength as a simple yet powerful predictor of all-cause mortality [16:45]; Is muscle strength causal or just a marker of health? [20:00]; Why VO2 max, strength, and muscle mass are powerful health markers: a reflection of long-term consistent effort [22:30]; How muscle mass and strength enhance healthspan by supporting metabolic health, inflammation control, recovery from illness, mobility, and fall prevention [23:45]; How muscle mass and strength decline with age, and why it's essential to act early to slow decline and preserve function later in life [30:30]; The foundational principles of building muscle strength and size through resistance training [35:30]; How to apply “progressive overload” for long-term strength and muscle gains [39:30]; The difference between concentric and eccentric muscle contractions and how each impacts strength, hypertrophy, and injury prevention [44:45]; The differences between muscle fiber types, and how aging disproportionately affects fast-twitch fibers responsible for power [50:15]; How to effectively train for power [52:00]; Training intensity: the benefits and safety of using the “reps in reserve” method [53:00]; How to balance compound and isolation exercises in a workout routine, and why compound lifts are foundational [55:45]; Can bodyweight exercises build muscle as effectively as weight training? [57:45]; How women can effectively build strength and muscle: key considerations [59:15]; Effective methods for tracking progress in strength [1:01:15]; Effective methods for tracking progress in muscle mass, and how to interpret results from a DEXA scan [1:04:30]; How to balance workout frequency with recovery for optimal results [1:06:45]; How to recognize signs of overtraining and when to consider taking rest days [1:10:15]; Avoiding injury: how beginners or returning lifters can start resistance training safely [1:15:15]; Protein: recommended intake, quality sources, timing of consumption, and more [1:17:30]; How fasting and calorie restriction affect muscle mass and what can be done to minimize muscle loss [1:24:15]; Key nutritional factors beyond protein that support muscle growth: hydration, creatine, and recovery [1:27:45]; The impact of hormones, sleep, stress, and consistency on muscle building and recovery [1:28:45]; How to structure an effective workout routine for a younger person that is new to resistance training [1:31:30]; How to modify beginner resistance training programs for older individuals to prioritize safety and gradual progress [1:35:30]; Should beginners start with machines or free weights when resistance training? [1:36:30]; How experienced lifters should modify their training to support healthspan and performance in later life [1:38:00]; and More. Connect With Peter on , , and
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#348 ‒ Women’s sexual health, menopause, and hormone replacement therapy (HRT) | Rachel Rubin, M.D.
05/12/2025
#348 ‒ Women’s sexual health, menopause, and hormone replacement therapy (HRT) | Rachel Rubin, M.D.
Rachel Rubin is a board-certified urologist and one of the nation's foremost experts in sexual health. In this episode, she shares her deep expertise on the often-overlooked topic of women’s sexual health, exploring why this area remains so neglected in traditional medicine and highlighting the critical differences in how men and women experience hormonal decline with age. Rachel explains the physiology of the menstrual cycle, the complex hormonal shifts of perimenopause, and the wide-reaching health risks associated with menopause, including osteoporosis, cardiovascular disease, dementia, and recurrent urinary tract infections. She also breaks down the controversy surrounding hormone replacement therapy (HRT), particularly the damaging legacy of the Women’s Health Initiative study, and provides guidance on the safe and personalized use of estrogen, progesterone, and testosterone in women. With particular emphasis on local vaginal hormone therapy—a safe, effective, and underused treatment—Rachel offers insights that have the potential to transform quality of life for countless women. We discuss: Rachel’s training in urology and passion for sexual medicine and women’s health [3:00]; Hormonal changes during ovulation, perimenopause, and menopause: why they occur and how they impact women’s health and quality of life [5:30]; Why women have such varied responses to the sharp drop in progesterone during the luteal phase and after menopause, and the differing responses to progesterone supplementation [14:45]; The physical and cognitive health risks for postmenopausal women who are not on hormone therapy [17:45]; The history of hormone replacement therapy (HRT), and how misinterpretation of the Women’s Health Initiative study led to abandonment of HRT [20:15]; The medical system’s failure to train doctors in hormone therapy after the WHI study and its lasting impact on menopause care [29:30]; The underappreciated role of testosterone in women’s sexual health, and the systemic and regulatory barriers preventing its broader use in female healthcare [35:00]; The bias against HRT—how institutional resistance is preventing meaningful progress in women’s health [46:30]; How the medical system’s neglect of menopause care has opened the door for unregulated and potentially harmful hormone clinics to take advantage of underserved women [53:30]; The HRT playbook for women part 1: progesterone [57:15]; The HRT playbook for women part 2: estradiol [1:05:00]; Oral formulated estrogen for systemic administration: risks and benefits [1:13:15]; Topical and vaginal estrogen delivery options: benefits and limitations, and how to personalize treatment for each patient [1:17:15]; How to navigate hormone lab testing without getting misled [1:24:15]; The wide-ranging symptoms of menopause—joint pain, brain fog, mood issues, and more [1:31:45]; The evolution of medical terminology and the underrecognized importance of local estrogen therapy for urinary and vaginal health in menopausal women [1:37:45]; The benefits of vaginal estrogen (or DHEA) for preventing UTIs, improving sexual health, and more [1:41:00]; The use of DHEA and testosterone in treating hormone-sensitive genital tissues, and an explanation of what often causes women pain [1:50:15]; Is it too late to start HRT after menopause? [1:56:15]; Should women stop hormone therapy after 10 years? [1:58:15]; How to manage hormone therapy in women with BRCA mutations, DCIS (ductal carcinoma in situ), or a history of breast cancer [2:00:00]; How women can identify good menopause care providers and avoid harmful hormone therapy practices, and why menopause medicine is critical for both women and men [2:06:00]; and More. Connect With Peter on , , and
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#347 – Peter’s takeaways on mastering sleep, dealing with chronic pain, developing breakthrough cancer drugs, transforming healthcare with AI, advancing radiation therapy, and healing trauma | Quarterly Podcast Summary #5
05/05/2025
#347 – Peter’s takeaways on mastering sleep, dealing with chronic pain, developing breakthrough cancer drugs, transforming healthcare with AI, advancing radiation therapy, and healing trauma | Quarterly Podcast Summary #5
In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions with Jeff English on the journey to healing from trauma; Ashley Mason on improving sleep and CBT-I; Sanjay Mehta on misconceptions around radiation and its use in cancer therapy and treating inflammatory conditions (such as arthritis and tendonitis); Sean Mackey on understanding and treating acute and chronic pain; and Susan Desmond-Hellmann on insights from her extraordinary career that pertain to the use of AI in medicine, understanding cancer, and the development of cancer therapeutics. Additionally, Peter shares any behavioral changes he’s made for himself or his patients as a result of these fascinating discussions. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Summary of episode topics [1:45]; Jeff English episode: how trauma shapes behavior and identity, and the value of understanding personal adaptations and working through unresolved emotional wounds [3:45]; Practical behavioral changes and emotional tools Peter has applied since the Jeff English episode [13:00]; Ashley Mason episode: treating insomnia using CBT-I and practical behavioral techniques for improving sleep quality [19:15]; When to seek professional care for sleep issues [30:30]; Sanjay Mehta episode: radiation therapy’s evolution, its underused potential in treating inflammatory conditions, and the cultural misconceptions surrounding radiation exposure [33:45]; Peter’s predictions and insights for the upcoming Formula 1 season [43:15]; Sean Mackey episode: the neuroscience, classifications, and treatment strategies for chronic pain, and the importance of personalized care [57:45]; Susan Desmond-Hellmann episode: how AI is revolutionizing medicine through advancements in drug development, biomarker discovery, and the potential of training models on private clinical data [1:05:45]; More from Susan Desmond-Hellmann: why cancer is so difficult to treat with drugs, the promise of immunotherapy, and the long-term hope for systemic treatments [1:14:00]; and More. Connect With Peter on , , and
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